Secondary removal of retained bone fragments in missile wounds of the brain.

Secondary operations for the removal of retained bone fragments have been performed in 116 of the 1133 casualties with craniocerebral missile wounds incurred in the war in Vietnam, 1967 to 1970. Various complications developed in 19 of these 116 casualties. Dehiscence of the wound occurred in eight patients, five of whom developed a cerebrospinal fluid fistula. Infection manifested itself in 16 cases with retained bone fragments prior to their secondary removal; however, infection first became apparent after the secondary operation in seven patients. Two of the seven patients with infection died. The neurological deficit became worse in four of the 116 patients following the secondary removal of a bone fragment: there was complete resolution of that deficit in one, and return to the neurological status existing after the initial operation in another; the other two patients developed a permanently disabling neurological deficit, an incidence of 1.7%.